Where did all the mental healthcare facilities go?

Teresa was a lively child. She liked to play with her dolls and make up adventurous stories to share with her family. However, by the time Teresa was five, her happy disposition changed. Her mother died and the sudden loss was a severe blow to the young child. Now Teresa was anxious and depressed. She became a target of bullying in school and oftentimes cried in silence. Going to school became more and more difficult. Teresa became withdrawn and, over the years, her irrational behavior caused her father great concern.

What happens next depends on when Teresa was born.

Had Teresa been born in the early 1900s, she may have been placed in a state psychiatric hospital. For Teresa and others like her, institutionalized care increased access to mental health services. The state hospital model was based on the concept that patients lived in the hospitals and were treated by professional staff, relieving families who lacked the financial resources and medical knowledge to provide proper care for relatives. By 1900, the U.S. government had funded the building of 32 state psychiatric hospitals.

This institutional model increased care. However, in effect, the state hospitals were often underfunded and understaffed. By the mid-1950s, the U.S. government deinstitutionalized mental health services and, in return, states promised to provide community-oriented care as the new model. But this effort, too, was—and has been—underfunded.

According to the Treatment Advocacy Center, in 1950, before the state hospital closures, there were 560,000 beds for patients needing psychiatric treatment. But in 2010, there were only 43,318 beds available – the same number that was available in 1850 per capita before the state hospitals were built.

Today, there are fewer psychiatric beds in our nation for crisis care than in the 1950s. Take a minute to let that sink in.

Fewer beds.

A larger population.

The state hospitals were closed but the promised community mental healthcare facilities were never built. Instead, individuals challenged with mental illness began showing up in emergency rooms and prison cells—neither of which are equipped to treat mental illness.

So if Teresa was born in the early 2000s, she and her family may feel they have nowhere to turn. Teresa’s struggle with mental illness may be left untreated. At some point, she may drop out of school or experiment with substance abuse.

Teresa’s story is not unusual. Approximately one-half of all mental illnesses begin by age 14. One in five children suffer from mental illness, and of those, only 20 percent receive treatment.

What’s more, an overwhelming majority of Texas counties are designated as Mental Health Professional Shortage Areas, communities without a sufficient number of mental health care workers. Clearly, there is an opportunity for Texans to improve the way we care for children with mental illness.